Cocaine-related symptoms in patients presenting to an urban emergency department

Cocaine abuse is a serious social problem that precipitates a significant number of emergency hospital encounters. To determine the nature of cocaine-related symptoms, we studied patients with cocaine use presenting to all adult services of an urban emergency department.

Review of consecutive cases, with analysis of clinical features.

All adult EDs of an urban teaching hospital.

Patients acknowledging recent use of cocaine (within 72 hours) and/or with cocaine detected on a toxicologic screen.

Psychiatric complaints accounted for 44 (30.6%) presentations, followed by neurologic (17.4%), cardiopulmonary (16%), trauma (11.8%), and addiction-related (11.1%) symptoms. Cardiopulmonary symptoms were more frequently associated with intranasal than with IV or smoked cocaine (P = .003). Suicidal intent was the most common psychiatric reason for presentation, occurring in 24 patients (16.6%). Seventeen presented with trauma, including three involved in motor vehicle accidents.

Cardiopulmonary symptoms such as chest pain and palpitations may be significantly more frequent in patients who use intranasal cocaine; suicidal intent is common among patients presenting with psychiatric symptoms related to cocaine; and the range of cocaine-related symptoms is varied, including not only psychiatric and cardiopulmonary symptoms but also trauma.